Arthroscopic_ACL_Reconstruction_DITO
                     D E L H I  I N S T I T U T E  O F  T R A U M A  &  O R T H O PA E D I C S
Arthroscopic ACL
Reconstruction
A Complete Guide to Diagnosis, Surgery & Recovery
Dr. Shekhar Srivastav  |  HOD, DITO – Sant Parmanand Hospital
21+ Years of Arthroscopy Experience  •  “Freedom From Pain”
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B E F O R E  W E  B E G I N
About This Presentation
▪ Prepared as a general patient-education overview of ACL injury and 
arthroscopic reconstruction.
▪ Compiled with reference to clinical information published by Delhi 
Institute of Trauma & Orthopaedics (DITO).
▪ Intended for general awareness only — it does not replace an in-
person consultation.
▪ Always consult an orthopedic specialist for a diagnosis and treatment 
plan suited to your specific knee.
DITO consultation & examination suite
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R O A D M A P
What We'll Cover
1. About DITO 2. Knee & ACL 3. ACL Injury 4. Diagnosis
Our team & facilities Anatomy basics Causes & symptoms Exam & imaging
5. Treatment 6. Surgery 7. Recovery 8. FAQs
Options available Step-by-step Rehab timeline Outlook & answers
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S E C T I O N  1  O F  8
About DITO & Dr. Shekhar Srivastav
The team behind your ACL reconstruction
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O U R  I N S T I T U T E
Delhi Institute of Trauma & 
Orthopaedics
▪ DITO is the orthopedic and trauma unit led by Dr. Shekhar Srivastav 
at Sant Parmanand Hospital, Delhi.
▪ Core focus areas include knee & shoulder arthroscopy, joint 
replacement, robotics-assisted knee replacement, and trauma care.
▪ Guided by the motto “Freedom From Pain.”
▪ Combines arthroscopic precision with structured, supervised 
rehabilitation for lasting results.
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Y O U R  S U R G E O N
Meet Dr. Shekhar Srivastav
Head of Department (HOD), DITO — Sant Parmanand Hospital, Delhi. Recognised for advanced arthroscopic ACL reconstruction and robotics-
assisted knee replacement.
21+ 2 HOD
Years of Arthroscopy & Orthopedic Experience Practice Locations Across Delhi Delhi Institute of Trauma & Orthopaedics
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V I S I T  U S
Where We Practice
Prime Speciality Clinic Sant Parmanand Hospital
182, 1st Floor, Jagriti Enclave, Vikas Marg, Delhi-110092 Plot No. 1, 2 & 3, Park Area, Yamuna Bazar, Ring Road, Kashmiri Gate, Delhi-110006
Call Us Online
+91-9971192233 www.delhiarthroscopy.com
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O U R  FA C I L I T Y
A Patient-First Environment
▪ Modern consultation and examination rooms designed for patient 
comfort.
▪ Advanced diagnostic support alongside clinical evaluation.
▪ Clinical precision paired with an emphasis on patient comfort.
▪ Dedicated support for post-operative care and physiotherapy follow-
up.
Consultation & examination room
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O U R  FA C I L I T Y
A Dedicated Arthroscopy 
Operating Theatre
▪ Purpose-built suite equipped for high-definition arthroscopic surgery.
▪ Controlled operating environment supporting infection-control 
protocols.
▪ Specialised instrumentation for precise ligament reconstruction.
▪ Full perioperative monitoring throughout every procedure.
Arthroscopy operating theatre
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S E C T I O N  2  O F  8
Understanding the Knee & the ACL
The anatomy behind the injury
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A N AT O M Y  B A S I C S
How a Normal Knee Works
▪ The knee is the largest joint in the body — and one of the most frequently injured.
▪ It is formed by the lower end of the femur (thigh bone), the upper end of the tibia (shin bone), and the patella (kneecap).
▪ The patella glides within a groove on the end of the femur as the knee bends and straightens.
▪ Articular cartilage covers the contact surfaces, cushioning the bones and allowing them to glide smoothly.
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T H E  S TA B I L I S E R S
The Four Ligaments of the Knee
ACL — Anterior Cruciate PCL — Posterior Cruciate
Centrally placed; controls forward movement of the shin bone. Centrally placed; controls backward movement of the shin bone.
MCL — Medial Collateral LCL — Lateral Collateral
Peripherally placed on the inner knee; resists inward stress. Peripherally placed on the outer knee; resists outward stress.
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A N AT O M Y  B A S I C S
Meniscus & Articular Cartilage
▪ The medial and lateral menisci are C-shaped cushions of fibrocartilage sitting between the femur and tibia.
▪ They act as shock absorbers and add secondary stability to the joint.
▪ Articular cartilage lines the ends of the femur, tibia, and patella, enabling smooth, low-friction movement.
▪ Ligaments, menisci, and cartilage work together — an ACL tear can place extra strain on the others.
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A N AT O M Y  B A S I C S
What Does the ACL Actually Do?
Controls Forward Sliding Adds Rotational Control
Prevents the tibia from shifting too far forward beneath the femur. Works with the other ligaments and menisci for overall stability.
Enables Pivoting Most Commonly Injured
Critical for cutting, pivoting, and sudden changes of direction. The ACL is the most frequently injured ligament of the knee.
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W H Y  I T  M AT T E R S
Why the ACL Matters in Sport
▪ An intact ACL is essential in football, basketball, skiing, badminton and any pivot-and-cut sport.
▪ A knee that gives way under load limits performance and confidence during play.
▪ Instability also raises the risk of secondary injury to the meniscus and cartilage.
▪ This is why ACL tears are managed with particular attention in young, active individuals.
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S E C T I O N  3  O F  8
ACL Injury: Causes & Symptoms
Recognising the injury early
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M E C H A N I S M  O F  I N J U R Y
How Does the ACL Get Injured?
Sudden Pivoting Awkward Landing
A sharp change of direction or twist on a planted foot. Landing off-balance from a jump.
Direct Blow Road Traffic Accidents
A direct impact to the knee during contact sport. A common non-sporting cause of ACL injury.
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M E C H A N I S M  O F  I N J U R Y
Who Is Most at Risk?
▪ ACL injury is seen most often in young, active individuals.
▪ Athletes playing football, basketball, skiing, and other pivoting sports are commonly affected.
▪ It is also a frequent finding after road traffic accidents.
▪ Both recreational and competitive-level athletes can be affected.
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WA R N I N G  S I G N S
Recognising an ACL Tear
Giving Way Pain & a “Pop” Swelling
A sudden feeling of instability in the knee. Pain at the moment of injury, often with an audible Swelling typically develops within hours of injury.
pop.
Reduced Motion Trouble Weight-Bearing
Difficulty fully bending or straightening the knee. Difficulty putting full weight on the affected leg.
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L I V I N G  W I T H  I N S TA B I L I T Y
Living with an Unstable Knee
▪ Twisting and turning movements can trigger episodes of instability.
▪ Many patients are unable to continue sport or strenuous activity.
▪ In more severe cases, even routine daily activities become difficult.
▪ Left unaddressed, ongoing instability can raise the risk of secondary meniscus and cartilage damage over time.
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S E C T I O N  4  O F  8
Diagnosis
Confirming an ACL tear accurately
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S T E P  O N E
Clinical Assessment
▪ A detailed history of how the injury occurred is the starting point.
▪ The surgeon assesses pain, swelling, and any sense of instability.
▪ The injured knee is compared carefully with the uninjured side.
▪ The exam also screens for associated meniscus or cartilage injury.
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C L I N I C A L  E X A M I N AT I O N
Special Tests Used by Orthopedic Surgeons
Lachman Test Anterior Drawer Test Pivot Shift Test
A widely used, sensitive test for assessing ACL Checks for excess forward movement of the tibia. Assesses rotational instability of the knee joint.
integrity.
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I M A G I N G
Confirming the Diagnosis with MRI
▪ MRI is the imaging investigation of choice when an ACL tear is suspected.
▪ It clearly shows the ligament, meniscus, and articular cartilage.
▪ Findings help the surgeon plan the surgical approach and graft choice.
▪ X-rays may also be used to rule out any associated fracture.
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C L A S S I F I C AT I O N
Grading ACL Injuries
Grade I Grade II Grade III
• Mild sprain of the ligament fibres • Partial tear of the ligament • Complete tear of the ligament
• Ligament remains functionally intact • Some looseness on examination • Noticeable knee instability
• Knee generally remains stable • May be managed case-by-case • Most commonly seen before reconstruction
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S E C T I O N  5  O F  8
Treatment Options
Choosing the right path forward
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C O N S E R VAT I V E  C A R E
When Is Non-Surgical Management Considered?
▪ Some partial tears in a knee that remains stable may be managed without surgery.
▪ It may suit lower-demand patients willing to modify high-risk activities.
▪ Structured physiotherapy strengthens the muscles supporting the knee.
▪ A brace may provide additional support during daily activity.
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S U R G I C A L  C A R E
When Is Surgery Recommended?
▪ A complete ACL tear with ongoing instability is a common indication.
▪ Active individuals hoping to return to pivoting or contact sport often benefit from reconstruction.
▪ Associated meniscus or cartilage injury may tip the decision toward surgery.
▪ Recurrent episodes of the knee “giving way” are an important signal.
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S U R G I C A L  C A R E
Goals of ACL Reconstruction
Restore Stability Protect the Joint Regain Strength Return to Activity
Rebuild a functional, stable Reduce further meniscus & cartilage Recover full strength & range of Enable a safe return to sport & daily 
ligament. damage. motion. life.
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W H Y  E X P E R I E N C E  M AT T E R S
Choosing the Right Specialist
Precise tunnel placement and individualised graft selection are central to a successful, lasting reconstruction — outcomes that come with 
focused experience.
21+ HOD 1:1
Years of Focused Arthroscopy Experience Delhi Institute of Trauma & Orthopaedics Individualised Surgical Planning
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S E C T I O N  6  O F  8
The Surgical Procedure
A minimally invasive, step-by-step approach
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T H E  T E C H N I Q U E
What Is Arthroscopic Surgery?
▪ Arthroscopy is a keyhole, minimally invasive surgical technique.
▪ A small camera (the arthroscope) and fine instruments are inserted 
through tiny incisions.
▪ The ACL is reconstructed with minimal disruption to the surrounding 
tissue.
▪ This precise approach supports a faster recovery with less post-
operative pain than open surgery.
The arthroscopy operating suite
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G R A F T  S E L E C T I O N
Choosing the Graft
Hamstring Tendon BTB Graft Quadriceps Tendon Allograft
• Autograft from the patient's own • Bone-Patellar Tendon-Bone • Autograft from the quadriceps • Donor tissue, used in select cases
hamstring autograft tendon
• Considered on an individual basis
• A widely used graft choice • Taken from the patient's own • An alternative autograft option
• Discussed case-by-case with the 
knee
• Individualised to the patient • Chosen based on assessment surgeon
• Considered for select cases
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S T E P  1  O F  4
Anaesthesia & Arthroscopic Access
▪ The procedure is performed under spinal or general anaesthesia.
▪ A few small keyhole incisions are made around the knee.
▪ The arthroscope is inserted, projecting a magnified view of the joint onto a screen.
▪ The entire joint is inspected for any associated injury before proceeding.
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S T E P  2  O F  4
Removing the Torn Ligament
▪ The torn remnant of the ACL is carefully excised arthroscopically.
▪ Any associated meniscus or cartilage injury is addressed at the same sitting.
▪ The joint surfaces are prepared ahead of graft placement.
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S T E P  3  O F  4
Preparing the Bone Tunnels
▪ Precise tunnels are created in the femur and tibia using specialised guides and instruments.
▪ Accurate tunnel position is critical for the new graft to behave like a natural ACL.
▪ Every step is guided by direct arthroscopic visualisation for accuracy.
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S T E P  4  O F  4
Graft Placement & Fixation
▪ The prepared tendon graft is passed through the femoral and tibial 
tunnels.
▪ The graft is secured in place using specialised screws or fixation 
devices.
▪ Over the following months, the graft gradually integrates with the 
surrounding bone.
▪ This restores stability to the reconstructed knee.
Arthroscopic graft fixation in progress
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W H Y  A R T H R O S C O P Y
Advantages of the Arthroscopic Technique
Minimal Scarring Less Trauma Faster Mobilisation Precision
Only a few small keyhole incisions. Reduced tissue disruption & post-op Patients are up and walking sooner. Camera-guided accuracy 
pain. throughout.
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S E C T I O N  7  O F  8
Recovery & Rehabilitation
The road back to full function
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I M M E D I AT E LY  A F T E R  S U R G E R Y
The First 24 Hours
Same-Evening Walking Brace & Cane Support Exercises Begin Day 1
Patients can walk the same evening as their surgery. Initial walking is supported with a brace and walking Strengthening & range-of-motion exercises start the 
cane. next day.
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H O S P I TA L  S TAY
Hospital Stay & Discharge
▪ Patients are typically discharged on the 2nd or 3rd day after surgery.
▪ Pain is monitored and managed closely throughout the stay.
▪ Patients are guided on brace use and precautions before going home.
▪ Around 2–3 weeks of rest or leave from work or studies is generally advised.
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R E H A B I L I TAT I O N
Early Rehabilitation Phase
▪ Supervised physiotherapy focuses on regaining full range of motion.
▪ Progressive strengthening of the muscles around the knee begins early.
▪ Swelling control and gait (walking pattern) training are emphasised.
▪ Most patients walk without support within about 10–14 days, depending on individual progress.
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R E C O V E R Y  M I L E S T O N E S
A Typical Recovery Timeline
Day 0 Day 2–3 ~3 Months
Walking the same evening, Discharge from hospital. Slow jogging & more strenuous 
supported by a brace and cane. activity permitted.
1 2 3 4 5 6
Day 1 10–14 Days 8–9 Months
Range-of-motion & Walking without support, Return to active sport.
strengthening exercises begin. depending on progress.
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R E H A B I L I TAT I O N
The Role of Physiotherapy
▪ Structured physiotherapy is central to a successful long-term 
outcome.
▪ Progressive, carefully graded loading protects the healing graft.
▪ Balance and proprioception training help reduce the risk of re-injury.
▪ Sport-specific training precedes any return to competitive play.
Guided knee rehabilitation in progress
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S E C T I O N  8  O F  8
Safety, Outlook & FAQs
What to expect, long term
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S A F E T Y
Risks to Be Aware Of
▪ As with any surgery, risks can include infection, stiffness, or graft-related issues.
▪ These are uncommon with modern arthroscopic technique and careful post-operative care.
▪ Your surgeon will discuss your individual risk factors before the procedure.
▪ Promptly report any unusual pain, swelling, redness, or fever after surgery.
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G E T T I N G  B A C K  T O  S P O R T
Returning to Sport Safely
▪ Graft strength and knee function are reassessed before any return to sport is cleared.
▪ More strenuous activity generally begins around the 3-month mark.
▪ Return to active, pivoting sport is typically considered around 8–9 months after surgery.
▪ A gradual, criteria-based return helps reduce the risk of re-injury.
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L O O K I N G  A H E A D
Long-Term Outlook
Full Activity Ongoing Conditioning Regular Follow-Up Lower Re-Injury Risk
Most patients resume sport & daily Continued strength work protects Supports long-term joint health. Strong supporting muscles help 
activity without restriction. the reconstructed knee. protect the knee.
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C O M M O N  Q U E S T I O N S
Frequently Asked Questions
Is ACL surgery painful? Is the graft taken from my own body?
Q Q
Modern arthroscopic technique and structured pain management make discomfort In most cases, yes — commonly the hamstring, BTB, or quadriceps tendon.
manageable for most patients.
How soon can I walk after surgery? How long is the hospital stay?
Q Q
Most patients walk with support on the same evening as their surgery. Usually around 2–3 days after surgery.
When can I return to sport? How long before I can return to work?
Q Q
Typically around 8–9 months, once strength and stability criteria are met. Generally 2–3 weeks of rest is advised before resuming work or studies.
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Get in Touch
Freedom From Pain
Dr. Shekhar Srivastav — HOD, DITO, Sant Parmanand Hospital
Prime Speciality Clinic, 182, 1st Floor, Jagriti Enclave, Vikas Marg, Delhi-110092
Sant Parmanand Hospital, Park Area, Yamuna Bazar, Ring Road, Kashmiri Gate, Delhi-110006
+91-9971192233
www.delhiarthroscopy.com
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